The Dance of Therapy: Attunement, Undertreating and TIBs
Therapy, at its essence, is like a dance—an ebb and flow of connection, rhythm, and responsiveness. This delicate dance thrives on attunement, the...
I love food and the joy of flavors- hot, sweet, sour, salty with temperatures warm and cold, while having different textures with each bite. There is so much in a good meal. Therapists are the same way. We each have our own flavor, temperature, and texture, which creates our way of "doing" therapy in our offices. A good therapist has developed their own style based on a culmination of life experiences, interests, personality, and TRAINING. There is an art to therapy.
Just like a chef makes the menu at your favorite restaurant, so does a therapist make their own mix of approaches in their office.
Attuning is what mothers do with their babies, they can tell when they are hungry or sleepy or need a diaper change without their child using words. Attuning for therapists means being able to read the subtleties in your clients facial expressions, body movements, and words to "know" or suspect what they need. I attune naturally to others but in my office, I check with each client to know if what I sense is accurate for that individual.
Being able to check in with clients is a powerful tool to understanding your client's needs, and it provides a place for the client to feel heard. Often our role as therapist is to be a corrective emotional experience. I am attempting to model effective behaviors so my client feels heard, understood, and even liked, while at the same time motivating them for change through accountability. All these plates on the table take time to learn how to work with and balance. It is through attuning that we know which plate to address first.
Now I am naturally loud, talk a-lot, warm, laugh as much as I can, and I am veraciously curious. My art of therapy is sriracha sauce, sugar, salt, warm or cold depending on the interaction and what the client needs. Just like my favorite Thai meal of coconut curry. It contains coconut milk, spices that are too hot to eat at times, and textures. It's what I call a food party. And like any good chef I decide what combination of flavors is needed for each client, and when is the best time to add certain flavors. These combinations are based on protocals that are evidence based and a dash of intuition and experience.
Authenticity as a therapist is an edited version of our authentic self because the therapist authenticity takes into account the client first. If in attuning to my client, laughter or confrontation would be helpful, I proceed. So client's need first, my authenticity second.
This was hard one for me after graduate school. I felt I was the opposite of what I was trained to be. I was very extroverted and loud and I perceived therapists as controlled. That was a long time ago. I now know we must be "real" with our clients. It's like they smell inauthentic actions. But my realness is always informed by my clients' needs and mental health issues. Attuning does not mean they like what I give them, it just means I am seeing the path ahead and sharing it with my clients so that we can move through their barriers.
I continue to maintain that I do not know where the client will end up until the road presents itself, but I have a general idea that is based on experience and training. Seeing their path takes lots of sessions of attuning with my client and checking in for accuracy. This process is facilitated with nonjudgemental curiosity.
As a child i was not curious about food but I was curious about the world around me, I loved a good adventure. In the woods by my house I would explore these unknown lands pretending they were another country. As an adult I do the same thing with food, and when working with clients. I love the discovery of how each person's mental health issues are shaped and maintained. It is my curiosity and authentic desire to help another human that carry each session.
Now therapy is not quite a food party, it is actually more like a four course meal. Where you must start at the beginning to get the desert at the end. I don't like fine china for these four course therapy sessions. Unless fine china is needed for change. Fine china requires control and thought when it is used. So at times therapy must use protocols like EMDR, ERP, RODBT, DBT and many others. We also use therapy customs which are basically how we are trained.
These protocols produce outcomes. They are like a map through the forest. If we follow the steps of thousands before us we can facilitate our clients breaking free from lots of mental health issues. It just takes training and lots of it. When I was a new therapist I didn't realize the gravity of formal trainings. I would take different courses on different topics.
These are protocols that have been perfected and studied have specific processes that produce outcomes. Being thoroughly trained in these protocols facilitates changes for our clients quicker than just abstractly moving towards a goal that we are not certain about.
I use these protocol when needed and I break customs when the client needs another approach to treat their issue or when being human allows me to connect. I often use my spontaneity to address a pattern that I observe and to discuss and explore the most difficult of observations. It's reminds me of a lively dinner party. I break customs and etiquette to be honest with a client just like being real with someone during a party.
A great dinner party or restaurant always has an amazing environment. It's the setting for the experience. So my office is comfortable and neutral not because I think color is bad. I just love shades of grey. My entire house is variations of this color. I inhale a mild visual palette with a pop of color or a piece of art that catches the eye. That is my interior office- art and lots and lots of grey and wood. Neutral yet attention grabbing. Just like how I do therapy.
The art of therapy happens when I combine attuning to the clients, authenticity, and nonjudgemental curiosity with evidence based protocols to create a masterpiece. And like any established chef, experience is your best friend.
I have been licensed for 15 years, and it has taken time for me to perfect my therapy craft. Honestly I don't know if it will ever be "perfected" because we never stop learning. I am straight forward, sometimes what I call "mean." I am told by clients it's not actually mean its just mean in the eyes of being a therapist. We are trained to be like a bland soup that is easy to digest. The kind of mixture you give to someone following surgery or if they are sick. One can make this soup with no seasoning, vegetables, and broth. Next we place it all in the blender, and voila. A soup that goes down easy.
This watered down version of therapy is needed when one's soul is really sick, like when your client is grieving or traumatized severely, or even when one does trauma work. I take out my spices and go for a milder taste, this is attuning informed by lots of training and experience.
But me as a human is loud, excitable, and full of life and energy. So in my office when the issue permits I am spicy and it helps change occur for my most disturbed clients. Holding them accountable for change seems to give them something to hold onto and to create the most magnificent internal shifts.
I am looking for the spice in their life as well, the tastes of joy, of hope, and of action. The points where inspiration, motivation, and disgust with their lives inspire change internally and externally.
It's how our clients digest the experience that matters. So I add some spice or maybe sugar and see the results. Next I wait to see- Is change occurring? Because if not, I am not on the path of a masterpiece. Sometimes I send my clients to other therapists who can facilitate that change. It is not always me. I know my gifts and I know my weakness. And I know the therapists that have what I lack. So I refer some of my clients to them.
Countertransference can disempower you, exhaust you, and ultimately lead to burn out. It takes you out of your wise mind and puts you in your emotional mind, which is harmful to your clients and ultimately harmful to your own wellbeing. Your nervous system cannot be in fight, flight, freeze, or fawn regularly. Referring these clients on is essential.
Sitting in the soup of their misery is not what I am here to do. I am here for change. (Through attuning you will know what your client is looking for, and if you need to refer out based on where they are in the change model.) What kind of therapist are you? Are you spice-confrontation, sugar-warmth and understanding, or texture-holding clients to their goals? The art to therapy must come from who you are, your extensive training, and what the client needs.
In every town there are lots of other restaurants/therapists so we do not have to live in counter transference. Stuck in the suffering boat with our clients.
Often the change that clients want is comparable to a really hot Thai meal that they can barely ingest. If change is to occur it will be uncomfortable, maybe even the hardest thing they have willingly done in their lives. It may require mild, medium, hot, or Thai hot therapy. Ponder what spice you are and what spice your clients needs because it may not be the same temperature!
Remember we are not alone. Create your own team of therapists in your community. It takes a village even for us!
Therapy, at its essence, is like a dance—an ebb and flow of connection, rhythm, and responsiveness. This delicate dance thrives on attunement, the...
Exploring the critical role that ethics play in the field of mental health and the impact it has on both professionals and their clients. For the...
In the hushed confines of therapy rooms, where whispered truths echo and one's inner world unfolds, therapists often find themselves facing an...